November 2023

Dear CNO


Dear CNO,

I am interested in a career in cosmetic nursing, specifically providing Botox and filler injections to clients. Can I do this independently and what should I know?

At CNO, we get this kind of question a lot! Because cosmetic nursing is a growing and evolving field, there is lots of interest in this area. Nurses want to know their accountabilities and ensure they have the knowledge, skill, and judgment to practice safely.

Before you proceed, it’s helpful to review key concepts of authority, context and competence in our Scope of Practice standard. Let’s walk through each concept to help you understand your accountabilities when providing this kind of client care.


It’s important to understand where the authority to provide these procedures comes from. Administering a substance by injection, like Botox or fillers, is a controlled act that nurses can perform with an order (direct or directive) from an authorized provider. Authorized providers in this case include nurse practitioners (NPs) and physicians. So, if you’re an RN or an RPN, you’ll need to collaborate or work with an NP or physician. Even if you are operating your own business, RNs and RPNs are still required to obtain proper authorization (i.e., an order from an authorized prescriber) for the controlled act of administering a substance by injection.

You must also ensure you document the care you provide. Consider where and how you will complete your documentation to ensure that confidentiality and privacy are always maintained.


Next, you need to think about the context for the care you will be providing and whether it is appropriate for the procedures. Ask yourself questions, such as does the environment provide access to the necessary resources and equipment for safe care? Are you able to follow evidence-based practices, including infection control practices? Are you able to follow the manufacturer’s guidelines? Is it an environment where your clients would feel safe and supported?

The other important element of context is your client. Is the procedure appropriate for the client? Are there any contraindications based on their health? Are they fully informed about what the procedure entails? Do they understand the required follow-up and when they need to seek medical attention should an adverse event happen? What is your procedure when an emergency occurs?


It’s important to remember cosmetic procedures require the same caution and care expected in any other area of nursing practice. Even with an order, you must ensure you also have the knowledge, skill, and judgment, to perform the activity safely, including being able to manage adverse reactions. As self-reflective practitioners, educational courses and training should be taken as needed to practice safely, as well as participation in our Quality Assurance Program.

If you plan to operate your own business, it may be helpful to review our Independent Practice guideline. This document outlines the ethical and legal responsibilities for nurses who are self-employed or operate their own business.

Lastly, CNO receives a number of complaints and reports related to cosmetic nursing.  We want you to understand that cosmetic nursing is a high-risk area of practice and nurses must ensure they can perform procedures competently and safely. Procedures done improperly can lead to adverse reactions, infections and potentially death. We want to support nurses in pursuing their independent practice in a safe and ethical way.

Thanks for writing, 
Jennifer Cheng, RN, MN, Advanced Practice Consultant

Further reading:

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